Madison doesn’t have HIV. At least she doesn’t think she does. She doesn’t know for sure because she’s never been tested.

“I’ve never gotten [an HIV test] because I have never been concerned about it,” said the 17-year-old who lives in Grand Haven, Mich. “Maybe I should because I’ve done some interesting things like sharing needles with friends while we gave each other tattoos and I have sex. I would be shocked if I did have it.”

Madison, whose last name isn’t being used to protect her identity, said she doesn’t know much about the potentially fatal virus that infects 50,000 people yearly, 1-in-4 of whom, the Centers for Disease Control and Prevention (CDC) reported, are teens. “I don’t hear about it much so I don’t really think about it either.”

Many teens are in the same boat: unsure of their status when it comes to HIV because they have not been tested. The same goes for other sexually transmitted diseases such as human papillomavirus (HPV) and chlamydia.

Only 22 percent of sexually active teens are taking advantage of health screenings for these diseases, according to the CDC. Various reasons for this avoidance surfaced in online interviews with a dozen teens. Financial barriers, fear and parental involvement were three of the major reasons.

The HPV vaccination is available at most health care centers and is usually covered by insurance or dispensed freely by the federally funded program Vaccines for Children, which covers immunizations for eligible minors.

But a three-shot process hinders teens from getting the full course of the vaccine for HPV, which can lead to cervical cancer and is a major cause of oropharyngeal cancers. Females age 15 to 24 have a 25 percent chance of being infected each year, according to the CDC.

About 38 percent of eligible female teens and 14 percent of male teens have received all three doses of the HPV vaccine, CDC data show.

Early Immunization Strategy
The strategy is for people to get immunized before becoming sexually active, after which they could be exposed to the virus, Dr. Gale Burstein, commissioner of health at Erie County Department of Health in New York, said in a phone interview.

Getting tested can be a big decision, said Burstein. “It’s something that significantly affects your health for the rest of your life and it could kill you if it’s not appropriately treated. Many people are afraid of receiving bad news. That could also be a reason why people don’t want to get tested.”

The earlier teens learn to pay attention to their own sexual health, the more likely they are to stick to healthy habits as they get older, said Debra Hauser, executive director of Advocates for Youth, based in Washington, D.C.

Hauser encourages teens to seek their parents’ support for getting tested but she understands that some parents will not support their children’s sexual development.

“America is kind of a home to a culture of shame, fear and denial around sexuality, especially for teenagers,” Hauser said. “There’s very little recognition that sexual development is normal and healthy.”

And that’s a problem, said Hauser. “Ignorance is nobody’s ally and in the era of HIV and AIDS young people need to be well informed.”

In the case of HPV, some parents see the vaccine as giving their children the “license to have sex,” said Hauser.

That was the case for Elizabeth Tibbe, 15, from Grand Haven, Mich. “It was a decision my parents made with my doctor, partially because of my age and what was in the vaccine,” she said in an email interview, explaining why she was not vaccinated.

Protection against HIV isn’t common either. Only 13 percent of high school students get HIV testing, finds surveys conducted by the CDC in 2013. Since HIV testing is not covered by most insurance, that’s part of the problem.

“If I had to pay for it by myself, cost would be a problem because I don’t have a job or a lot of money,” said high school junior Megan Khodl, from Lowell, Mich.

Another Barrier
Misunderstanding can also be a big barrier to teen screenings.

Michigan State sophomore Brooke Wisniewski, for instance, does not feel the need to get sexual health screenings since she has protected sex. But like many others, Wisniewski isn’t aware of the possible diseases a condom can’t prevent.

Wisniewski said she rarely gets any vaccines, much less ones that pertain to her sexual health.

“I just don’t really go to the doctors. I got vaccines when I was little and then once again when I started high school. I got the tetanus shot but I don’t really think I’ve gotten anything else.”

It’s also difficult for teens to get HIV testing without letting their parents know. Depending on the state, guardians can be informed of their minor’s results or could receive a payment notification on their insurance billing statement. To ensure privacy and confidentiality, teens are advised to ask about such issues when setting up an appointment. Some places will offer free HIV testing with confidential results.

Junior Greer Antel from Greenwich, Conn., has fears about the privacy of her results if she were to get tested for HIV. “I would worry about the confidentiality of the test because I wouldn’t want my peers to find out that it was necessary [for me to get tested] or that I may have HIV/AIDS,” Antel said.